Predicted shifts in payor mix with the help of a scenario analyzer for a leading pharmaceutical company

SUMMARY

The client’s managed care partnership strategies, rebates and reimbursement policies are constantly evolving in response to changes in market dynamics. The increased focus on specialty products and biologics add to complex payment rates and contracts. As a result, visibility into payor performance is hampered. The client wanted an integrated source of information.

APPROACH

We took a four-phased approach to this challenge:

We ﬁrst deﬁned the business problem by creating a framework, complete with key questions and hypotheses; these were then prioritized

We then studied the range of available datasets, evaluating the applicability and applying appropriate business rules

Basis step 2, an analytical model was created for segmenting the payor universe

Appropriate forecasting techniques were applied and response models were built at the product/payor level to gauge the impact of shortlisted factors on the mix

KEY BENEFITS

We were able to generate recommendations for each product in the portfolio based on the impact of signiﬁcant internal and external factors

Our solution enabled the client to build various ‘what-if’ scenarios, providing a prescriptive direction when creating payor mix for the future

RESULTS

The scenario analyzer allowed the client to understand the impact of different situations and consequently devise better strategies. The solution enabled the client to:

Analyze the entire payor situation and simulate scenarios to enable decisions on the right payor mix

Create contingency plans for any unforeseen circumstance with any major payor

Strategize more effectively in near real time and make data-backed business decision